Purpose To assess the views of emergency medicine physicians (EMPs) on the practice of providing unnecessary medical management in the emergency department. Methods All EMPs in Saudi Arabia were approached to participate in this cross-sectional study. A self-administered online survey that collected the participants’ demographic information and opinions regarding the unnecessary management provided by EMPs in Saudi Arabia was conducted between December 2020 and February 2021. SPSS 22.0 was used to analyze the data. Results A total of 181 EMPs returned the questionnaire. More than 80% of the participants believed that EMPs order unnecessary tests or procedures at least a few times per week. The major reasons for ordering unnecessary medical tests or procedures were “concern about malpractice issues” (60.8%), “not having enough time with a patient for meaningful discussion” (47%), and “just to be safe” (46.4%). More than 55% of the respondents also believed that EMPs are in the best position to address the problem of unnecessary testing. Conclusion Most of the EMPs who participated in this study recognized that ordering unnecessary tests is a serious problem that happens on a daily basis. Many factors and reasons were described by the participants, and multiple possible solutions were suggested to help overcome the issue. Evaluating physicians’ perspectives on the issue is a key step in addressing the problem and implementing appropriate interventions.

A pneumonia outbreak with an unknown microbial etiology was reported in Wuhan, Hubei province of China, on December 31, 2019. This was later attributed to a novel coronavirus, currently called as severe acute respiratory system coronavirus 2 (SARS-CoV-2). Coronavirus disease 2019 (COVID-19) mainly affects the respiratory system and can also cause acute or chronic damage to the cardiovascular system. We present a case of a 64-year-old female with past medical history of diabetes mellitus and hypertension who presented to the Emergency Medicine Department with shortness of breath and worsening chest discomfort, then had a ventricular fibrillation (VF) arrest while in triage, in the context of COVID-19 diagnosis. Cardiovascular complications during the COVID-19 pandemic should be brought to medical attention; it is crucial that physicians be aware of the complications and treat it as an emergency.

Background: There are limited data regarding potential triggering factors of pulmonary embolism (PE) in coronavirus disease 2019 (COVID-19) patients and its outcomes in comparison with non-infected PE patients. We aimed to identify the contribution of COVID-19 among patients diagnosed with PE and compare risk factors, laboratory results, and outcomes between COVID-19 PE patients and non-COVID-19 PE patients.Methods: This was a retrospective study of all PE patients between March 2020 and December 2020. The patients were segmented into two groups based on a COVID-19 nasopharyngeal swab result. Statistical analysis was used to determine the differences in risk factors, laboratory values, and outcomes.Results: A total of 58 patients were included. Females comprised 44.8% of the total sample. Overall, 16 patients (27.6%) were COVID-19 positive. Being non-Saudi was observed more in PE COVID-19 patients compared with non-COVID-19 patients (43.7% vs 4.8%, P = 0.001). Intensive care unit (ICU) admission occurred in 50% of COVID-19 PE patients. Conclusion: COVID-19 was associated with 27.6% of the PEs in our hospital. Being male or a foreign resident was observed to be associated with COVID-19 PE. Further studies with larger sample sizes are needed, but these results may help the medical community regarding the increased risk of PE among COVID-19 patients and provide evidence of some potentially predictive factors that can be used to identify COVID-19 in highrisk patients.

Background Trauma is considered a significant public health problem worldwide. Abdominal trauma is generally divided into blunt and penetrating. Blunt trauma could affect any organ, and the sequelae of such injury may not always be clinically apparent. Liver injury is one of abdominal trauma's most critical and fundamental complications. We aimed to investigate the mechanism, type, and extent of injuries for patients with liver trauma and compare the outcomes between operative and non-operative management. Methods This retrospective study analyzed data of patients with liver injuries who presented to King Khalid University Hospital, King Saud University from 2016 to 2022. Management included conservative, conservative to laparotomy, laparotomy, and interventional radiological procedures, including hepatic artery angioembolization and percutaneous transhepatic drainage. Injury severity was graded based on the American Association for the Surgery of Trauma (AAST) liver injury scale. Results We analyzed 45 liver injury patients, with mean age of 29.3 years and most of them being male (77.8%). The most common injury mechanism was blunt trauma (86.7%), whereas penetrating injuries accounted only for 8.9% of cases. The most dominant type of injury was laceration (95.6%), followed by contusion (28.9%). Regarding liver injury severity, the majority of patients (37.8%) had a grade 3 injury level as per AAST liver injury scale. Among all patients, 31 (68.9%) were hemodynamically stable, whereas 14 patients (31.1%) were unstable, with a mortality rate of 2.2%. Most patients (82.2%) underwent conservative management. Six patients (13.3%) require surgical laparotomy. Two patients (4.4%) who underwent conservative management first needed surgical laparotomy. The complication rate was 24.4%, with delirium being the most common (6, 13.3%), followed by fever and sepsis (3, 6.7%) and acute renal failure, pneumonia, cardiac arrest, biliary leaks, meningitis/seizures, which were all reported in a subset of patients. Conclusions Liver trauma is considered a significant public health problem worldwide. The management of traumatic liver injuries has evolved significantly over the years, with the addition of interventional radiological modalities, a more inclined approach toward non-operative management.